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Are you an adult with a runny nose or itchy eyes that won't improve? Before you consider other conditions, perhaps it's time for an allergy test.

Join us as our expert guests explain how allergies can develop and disappear at any age. They will also explain common symptoms you should look for, the best ways to accurately diagnose your allergies and how to reduce your symptoms. Plus, you'll hear more about the debate over whether or not childhood vaccinations can spark allergies as well.

As always, our expert guests answer questions from the audience.

Announcer:

Welcome to this HealthTalk webcast. Before we begin, we remind you that the opinions expressed on this webcast are solely the views of our guests. They are not necessarily the views of HealthTalk, our sponsors, or any outside organization. And, as always, please consult your own physician for the medical advice most appropriate for you.

Now here's your host, Heather Stark.

Heather Stark:

If you've had an allergy like hay fever since you were a child, chances are you are intimately acquainted with the sneezing, itchy eyes, fatigue, scratchy throat, and all the other annoying symptoms that go along with it. But what if you are in your thirties and suddenly experience allergy symptoms for the first time? It is possible to develop allergies later in life, and for someone who has never had them, it can be shocking.

Hello and thank you for joining us for Growing Into and Out of Allergies. I'm your host Heather Stark.

During this webcast, Dr. Pramod Kelkar, a board-certified, practicing allergist from Minnesota St. Paul and founder of the National Cough Clinic and chair of the Metro Asthma Coalition will explain how allergies can develop and disappear whether you are four or forty. We'll also learn the common symptoms you should look for, the best ways to accurately diagnose allergies and how to reduce your symptoms.

Welcome to our webcast, Dr. Kelkar.

Dr. Pramod Kelkar:

Thank you, Heather. It's a pleasure to be on the webcast.

Heather:

Dr. Kelkar, can you help us understand what allergies are and what are allergens, exactly? How does the body respond to an allergen?

Dr. Kelkar:

Well, Heather, allergies are basically overreactions of the body to a harmless substance. So, take an example of a pollen or pet dander. What happens is that when we inhale, let's say ragweed pollen or pet dander, then it goes into the body and it triggers a reaction into the body producing IgE antibodies, which are a type of chemicals in the body that are actually overproduced in people who have allergies. Once these IgE antibodies are produced, they actually attach to some cells in our body called mast cells that line the nose, the sinuses, the respiratory tract, the skin and the eyes. They are present at all of these places.

Once the IgE antibody combines with the mast cells and the allergen, the whole complex sets a chain reaction, and that chain reaction produces a variety of inflammatory mediators - or chemicals that produce inflammation, like histamines, leukotrienes - and that inflammation leads to swelling, leads to discharge, and then you get symptoms like sneezing; runny nose; congestion; stuffiness; itchy, watery, red eyes; asthma, and so on and so forth.

Heather:

Are there any other symptoms of allergies besides the itchy nose and eyes and all that?

Dr. Kelkar:

Well, the allergies can manifest, as you know, in the nose and sinuses, in the eyes, in the skin with itching. You have heard of patients who have had drug reactions, and they can have skin manifestations. You may have heard about patients who have food allergies, and that can cause anaphylaxis like throat closing, life threatening reactions where they cannot breathe. Those kinds of reactions can happen from allergies as well.

Heather:

Well, does the body react in the same way to all types of allergens, or are there different reactions?

Dr. Kelkar:

They are somewhat similar and somewhat different. The similarities are basically in the sense that all of these allergy reactions are mediated or produced via IgE type of antibody. The way they are different is because the manifestations are in different organs of the body. For example, food allergy can cause anaphylaxis or life threatening reactions. The pollens and pet dander typically cause nose, sinus, and eye allergies. So their location may be different, but in terms of immunological mechanisms there are a lot of similarities.

Heather:

And you say anaphylaxis. Do you want to explain just briefly what that is?

Dr. Kelkar:

Anaphylaxis is a medical term to describe life threatening reactions from food allergy, from drug allergy. They commonly happen from a food allergy, though. People must be familiar with peanut allergy causing life threatening reactions where you have to rush to the emergency room because you cannot breathe, and then you have to do injections like adrenaline, epinephrine, EpiPen, and Twinject.

Heather:

Are children or adults more likely to get these allergies?

Dr. Kelkar:

Children as well as adults can both develop allergies. And, in fact, in my practice I see 50 percent children and 50 percent adults. But if you look at the literature, you will find that most of the allergies start in your childhood. That does not mean that if you didn't have allergy until your adult life that you will never have allergies, because allergies can start at any point in our life.

Heather:

Well, do they tend to run in families, these allergies?

Dr. Kelkar:

Yes. They of course run in families. In fact, if you don't have any family member who has allergies, then you have about 10 percent chance of developing allergies. That's just the population statistics, about 10 to 20 percent. If you have one family member with allergies, like your mother or father, then your chance doubles, so it is about 20 to 50 percent or so. And if you have both family members, like mother and father, with allergies then your chance of developing allergy would be about 50 to 75 percent. So, as you can see, the more family members that have allergies, the more your chances are for developing allergies. So I always tell patients, your best bet in preventing allergies is choose your parents well.

Heather:

Does it matter what they are allergic to, or is it just the propensity for having an allergic reaction?

Dr. Kelkar:

It's actually just a predisposition to having allergies. So just because you are allergic to, let's say, ragweed pollen, that does not mean that when your child develops allergy, that the allergy will be to the ragweed pollen. It may be to something else. It's just a genetic predisposition in terms of concept, the details can vary.

Heather:

You said that you see about 50 percent children and about 50 percent adults, but it seems like children have more allergies to things like food or pets than adults do. Is that true?

Dr. Kelkar:

Yes. That's absolutely correct, Heather. Actually, children have more commonly allergies to foods than adults. The pet allergy is kind of equal.

Heather:

Are there other allergies that are more commonly seen in a younger person?

Dr. Kelkar:

Food allergies are more commonly seen in younger children, but most of the other allergies you can see at any age, like insect venom allergy, drug allergy and allergic rhinitis. Although allergic rhinitis tends to manifest early, in the first decade of life. But, having said that, I must say that there are a lot of adults who do not recall having allergy symptoms as a child but can develop allergies in their twenties, thirties or forties. In fact, sometimes I see patients who grew up on a farm with all the animals around them, and they never had an allergy to those animals until they were 30 or 40 years old, but now they are 30 or 40 years old and for the first time in life they are developing allergies to cat and dog, and they are kind of surprised that they grew up with cat and dog and never had allergy. How come they are having allergy right now?

Scientifically speaking, there are some things we do understand and some things that are still unclear. This is one that is not yet completely clear. One of things we understand scientifically is that allergies can manifest at any point in life. Also, there are quite a few people in whom allergies may have started early in life, but the symptoms may not have been bad enough that they noticed them or they remember them. So that may be the reason that they forgot that they actually had some allergies, but they were not bad enough, and during later life they are starting to develop more allergies.

Heather:

One of the thoughts I had was maybe they weren't exposed to the allergen? I have never been stung by a bee, so I wouldn't have any clue if I were allergic to a bee sting.

Dr. Kelkar:

That can happen too. With a bee sting, it can happen. With a cat and dog it's hard to tell why some people develop allergies beginning with their adult life even though they have had cats and dogs all their life.

Heather:

How are different types of allergies categorized?

Dr. Kelkar:

There are a variety of allergies: Allergic rhinitis, meaning nose and sinus problems coming from allergies; allergic conjunctivitis, meaning eye problems coming from allergies; and allergic asthma. The majority of asthma tends to be allergic in origin or tends to be triggered by allergens. Then there are drug allergies that usually manifest as skin reactions, sometimes as life threatening reactions from drugs. Then there are food allergies of course that can come as life threatening reactions or anaphylaxis that can also come as skin reactions or respiratory symptoms. We also have insect sting allergy where you get bitten by honey bee or you get bitten by a wasp or a yellow jacket and you develop throat choking, shortness of breath. Those are insect sting allergies. So we have a variety of allergies to environmental agents.

Heather:

I think I am going to come back full circle and ask this question again. If we have all these different types of allergies, why is it that someone develops one allergy and not another?

Dr. Kelkar:

Some things are clear, based on the science and based on research, and some research and some scientific information is still evolving. We do know that when people develop these IgE-type of antibodies that are actually overproduced by people who have allergies, those are allergen-specific. So let's say you are allergic to a cat. Your body is going to produce this IgE antibody specifically towards cat allergen, and you may not be allergic to honey bee or wasp. So if you get bitten by a honey bee, your IgE antibodies may not be overproduced, and you may not have a reaction. But if you get exposed to a cat, and you are allergic to a cat, your body is going to overproduce the IgE antibody specifically towards that allergen, and you are going to get that particular reaction. So yes, we do see patients who are restricted to one type of allergy and not necessarily all types of allergies simultaneously.

Heather:

One of the things I hear a lot about is pollen. Pollen seems to cause a lot of problems in people who have allergies, but what are some of the other common allergens that are out there?

Dr. Kelkar:

Pollen is certainly very common and tends to be seasonal. Other allergens would be dust mites, cockroach allergens, molds or fungi that are present all over indoor as well as outdoor. Pet dander, cat, dog, horse, rat, gerbil, guinea pig - all of those animals can cause allergies. Now, with cockroach allergy actually we know that it's been predominantly present in inner-city populations and has been shown by studies correlating with asthma attacks, leading to emergency room visits. Initial studies were done in inner-city Detroit population with cockroach allergy. That's quite common too. Pet allergy is very, very common. And dust mite allergy is all over. Most of the people who we see are allergic to pollen. Many of them are also allergic to dust mite in addition to pollen.

Heather:

Again, if some people are allergic to some things, and other people can tolerate the same thing just fine, where do those allergies come from? How do they get so specific?

Dr. Kelkar:

Those are mostly determined by your genes. And we always say that allergies and asthma - all the allergic diseases - need two things: They need genes, and they need the environment. Once you have the genetic predisposition and once you are exposed to the right kind of environment, the two together usually lead to manifestations of allergies.

Heather:

So when you say genes, there is not much we can do about that. What about the environment? Are there factors other than that genetic predisposition that will increase your likelihood of developing allergies in the first place?

Dr. Kelkar:

There is some research available right now. For example, some of your listeners might have heard about something called a hygiene hypothesis. And there were initially studies done in the eastern part of Germany, because the eastern Germany before their unification was little dirtier than the western part of Germany. They were not as super-clean. They had less use of antibiotics. When they united with western Germany and the western lifestyle, the super-clean lifestyle, their allergy incidence went up.

And that's where the initial studies came from, and they were duplicated around the world. And one of the messages from this hygiene hypothesis is that in the first two to three years of our life, our immune systems have a chance to develop, and that's the time our immune system is fighting the allergens, fighting the invaders into the body, the foreign substances, the bacteria, the viruses, the endotoxins, and is making itself stronger.

During those formative years, like in the first two to three years of life, if it gets exposed to nothing, no bacteria, no viruses, no allergens, no dust and nothing, and if we live in a bubble, kind of a super-clean environment, it really doesn't get a chance to develop itself. And what it does is shift the balance of our immune system from what we call T-helper 1 to T-helper 2 cell response. And the T-helper 2 cell response in the body basically makes you more prone to develop allergic diseases later in life.

So, one of the conclusions from this study is that having super-clean lifestyles in the first two to three years of life may not be such a good idea. And even cleanliness should be practiced in moderation. I am not suggesting your listeners go out and start making their houses messier beginning now, but even cleanliness needs to be practiced in moderation because our immune system definitely needs the chance to develop itself by fighting these things early in life.

Heather:

Dr. Kelkar, now that we have a good understanding of how allergies work, can you explain why some people are born with allergies while others develop them later in life?

Dr. Kelkar:

It goes back to the genetic predisposition, and we don't really quite understand based on the science why some people start developing early in life versus later. It may have to do with the environmental influences that may have to do with what environment we live in, what kind of indoor and outdoor exposures we have and so on and so forth. Some of these things are still unclear, so if some of the listeners want to know how we can modify our environment early in life so that we can prevent development of allergies 100 percent of the time, that information is still not known.

Heather:

How is it possible to all of a sudden become allergic to something you have been exposed to and tolerated well for years and years?

Dr. Kelkar:

Some of those things are still unknown. As I said, some of the science is sill evolving. And most of it is based on the genetic predisposition, but time will only tell what other material we come out of with scientific discoveries.

Heather:

Let's look at the flip side of that coin. What about people who are born with allergies? How is it possible for somebody who has had little or no exposure to an allergen to become allergic? Why does the body see an allergen as a threat?

Dr. Kelkar:

Typically we say that when somebody develops allergy, there are two types of phenomenon. One type of phenomenon is what we call as priming phenomenon. In this particular phenomenon, let's say your body gets exposed to a honey bee. You are bitten by a honey bee, and then your body develops what we call as IgE antibody, and body kind of primes itself for production of these IgE antibodies against this honey bee. And then when you get bitten a second time, your body is already primed to produce IgE antibodies directed specifically against honey bee, and then you produce them in enormous amounts and develop an allergic reaction.

So based on this understanding, you might say, “Well, if that's the case, then how come people develop allergic reaction to honey bee sting even if they are stung for the first time?” And once again, the answers to some of those questions remain unknown. We do know that most of the patients need two exposures for them to develop allergy. The first is called the priming exposure, and the second is actually allergic manifestation. But we have seen several patients, and we continue to see several patients in whom the first exposure itself as far as the patient can recall has led to an allergic reaction. And we don't exactly understand why the first exposure will lead to an allergic reaction when we scientifically know that priming has a big role in terms of allergic development.

Heather:

Can allergies get worse over time? For example, if somebody is only mildly allergic to something, can they become deathly allergic to the same thing later?

Dr. Kelkar:

Of course, they can get worse over time, and that's one of the reasons, Heather, we ask people that if they had a reaction to, let's say, peanuts, and if they had a reaction where they felt that their throat was funny, it was itching, and they had itching all over the body but they did not really pass out from it or they did not experience significant throat closing, we tell them to strictly avoid peanuts. And we do the allergy testing, and we go through the whole process of diagnosis of allergy because the second reaction can be worse than the first one.

And no one can predict whether the second reaction is going to be worse and how much worse, and whether the third reaction is going to be worse than the second one. We can't predict that. So we have to assume that there is a good chance that the second reaction can be worse and take steps to prevent that from happening.

Heather:

What about allergies disappearing? Can they just disappear? If you have an allergy, will you have it forever? And will you stop reacting to that allergen at some point in the future?

Dr. Kelkar:

The answer to that question is, it depends. It really is, because if you look at food allergy and if you look at children, the majority of children will outgrow milk allergy, egg allergy, but very few children will outgrow peanut allergy. For example, 85 to 90 percent of the children will not outgrow peanut allergy, but about 85 percent or so will outgrow their milk allergies. So it depends on what allergen you are talking about.

If you are talking about the environmental allergies, like allergies to pollen, allergy to mold, dust mites, pet dander - those people typically do not outgrow. I always tell patients environmental allergies are not like your shoe sizes that you suddenly outgrow one day. Usually once you have environmental allergies they will stick with you all your life. Having said that, people will notice that the symptoms they have from environmental allergy may change over a period of time. The intensity of symptoms may vary over a period of time, but as far as completely outgrowing them, it generally doesn't happen.

Heather:

Under what circumstances would somebody's allergies disappear?

Dr. Kelkar:

Once again we do not know exactly why exceptional patients will completely outgrow their allergies. What we do know is that in case of food allergy, when patients have food allergy, and if they avoid the foods for a certain period of time, that may give them an edge over people who are not avoiding foods once they're allergic, in terms of outgrowing allergy. But as far as what steps you can take so that you can outgrow your allergies faster, if that's your question, we don't understand exactly what particular steps one needs to take. But keep in mind, your listeners who have food allergies and other allergy issues, they need to say tuned with the allergy literature and science because the research is literally exploding. And there is phenomenal research right now being conducted at a variety of institutions across the country on food allergies, and I expect significant news from this research that can change people's lives within the next five years or so.

Heather:

Well, that's good. One of the things that I was wondering is you hear a lot about pregnancy or hormonal changes during adolescence changing somebody's allergies. Is that common?

Dr. Kelkar:

Yes. That can happen. In fact, in pregnancy, during puberty, the hormonal changes, allergies can get worse, but they sometimes can get better as well. In pregnancy, especially, we have to keep track of allergies very, very carefully because there are certain allergy medications that are okay to use in pregnancy, and there are certain allergy medications that are not okay to use in pregnancy. So those of your listeners who are pregnant or who have a relative or a friend who is pregnant and has allergies and is using medications, they need to make sure that their medications are okay to use in pregnancy, and they need to make sure of that with their healthcare provider or allergist.

Heather:

If allergies do disappear what's the likelihood that they are going to be returning later in life?

Dr. Kelkar:

Environmental allergies as well as food allergies can return later in life. So if somebody doesn't have allergies we always say, I [they] don't have allergies up until this point in time, because keep in mind that you can develop new allergies at any point in time. Again, it's an interaction of genetic predisposition and environmental factors.

Heather:

Well, we were talking about this a little bit earlier. It seems like there has been a rise in people suffering from allergies, at least from what you read in the media. Do you think this is true?

Dr. Kelkar:

Yes. There is a big rise in people having allergies: food allergies, environmental allergies, all sorts of allergies. Definitely there is a big increase, and this is around the world, not just in the United States.

Heather:

Is it an actual increase in number, or is it just an actual increase in knowing about those people?

Dr. Kelkar:

It's an actual increase in numbers in addition to being more aware of allergies than before. So it's both, but there is an actual increase in number of allergies nowadays than before.

Heather:

Why do you think we are becoming more and more allergic to our environment?

Dr. Kelkar:

Part of the reason can be the hygiene hypothesis that we are living our lives much cleaner than before, especially in the first two to three years of our lives that we are not exposed to bacteria, viruses, allergens, endotoxins, dust and those kinds of things that our immune system is not getting a chance to develop itself as it should. I remember when I was growing up, if you had to go to your backyard, you could go with bare feet.

But now people are so much concerned that even if a child wants to go to the backyard, they want them to put their shoes on and this thing and that thing, and you always wonder. Everything needs to be done in moderation. So the hygiene hypothesis explains some of the reason.

The other thing is now the environment is changing a lot. We all work with computers. Even children have their own computers these days. If you have a computer, it is very likely that you are going to spend time indoors more than outdoors. Indoor allergen exposure sometimes can be much higher than outdoor allergen exposure because nowadays we have all these new homes being built that are energy-efficient, meaning the air exchange system may be very tightly controlled. If it is too tightly controlled, there might be more allergen exposure in the indoor environment than in the outdoor environment. So, all those things contribute to development of allergies.

Heather:

So did I just hear you say we need to be outside more and get a little dirtier?

Dr. Kelkar:

Absolutely. I think that's good advice.

Heather:

Well, with allergies changing over time and varying so much from person to person, how do you determine a patient's specific allergies?

Dr. Kelkar:

If you want to find out what things you are allergic to, one thing you need to do is visit with your healthcare provider, your allergist, and get the testing done, because only by testing will you be able to determine what specific thing you are allergic to. That's the only way to determine it.

Heather:

Will a skin test tell you how allergic to something you are?

Dr. Kelkar:

Absolutely. A skin test is basically we take a drop of allergen and put it on your skin, either on your back or on your forearm, and then we have a slight pricking device. It's not a needle. I would say it's somewhat similar to a toothpick, and we prick through that drop of the allergen and then basically wait for 20 minutes. There’s no blood coming out through the skin. We just wait for 20 minutes and wait for the skin to react. And if your skin starts reacting by producing a red area around that drop and kind of raised above the surface of the skin like a small bubble, then that would tell us that you are developing an allergic reaction to that particular allergen. That's how we recognize [an allergic reaction] with the skin testing.

Heather:

And the bigger the bubble, the more allergic the person is? Does that make sense?

Dr. Kelkar:

Sometimes that is true, but not quite. There are some patients who may not have very big reactions, but their symptoms can be very severe. So, yes, sometimes we can get an idea about how severe the allergy is, but sometimes it's kind of pass or fail, are you allergic, are you not, based on the skin testing.

Heather:

Since we know a person's allergies can change, do you recommend allergy testing on a regular basis?

Dr. Kelkar:

Not on a regular basis, but let's say you had allergy testing five years ago, and let's say your symptoms are worse now. Then it's a good idea to do the testing. But let's say your allergies are about the same as one year ago, and you just had testing one or two years ago, we may accept the testing that was done that time. So it depends on how many years there have been in between your last testing and now. It also depends on what kind of symptoms are you having. It also depends on whether the treatment is working or not working.

Let's say you had allergy testing two years ago, but let's say whatever treatment you are doing right now is not working. Then we need to figure out, did you develop new allergies over the past two years? Is that the reason why the treatment is not working, or is there some other reason? And that's the time we may consider repeating it. So once again it kind of depends on a particular patient's situation.

Heather:

You are talking about identifying a person's allergies. Then how do you go about treating them? What medications are out there to help relieve allergy symptoms?

Dr. Kelkar:

In terms of treatment of allergy, we start with prevention and control first. So let's say I have a patient who has allergies, and we identify that the patient is allergic to dust mites. The first thing we will do is we will advise the patient on how to control dust mite exposure at home. Then the second thing we do is we treat it with medications, and there are a variety of medications available. There are tablets. There are nose sprays. There are chewable tablets. There are swallowing pills. There are liquids available that you can take. A variety of medications are available. If these medications don't work, then we go to the next step, and that is usually allergy shots or allergy immunotherapy or what we call as allergy vaccine or allergy injection therapy.

Heather:

What about over the counter medications? We see a lot of advertising for those on TV. Are they worth a try at all?

Dr. Kelkar:

Sure. There are some over the counter medications that are pretty good. There are some over the counter medications you need to use with extreme caution. For example, over the counter medications like Claritin (loratadine) and Zyrtec (cetirizine), recently Zyrtec went over-the-counter. It used to be a prescription medicine. It went over-the-counter. These are pretty good medicines, and people can try those medications and see how they feel. They have medications like Benadryl (diphenhydramine) people can try, but keep in mind that they can cause drowsiness. So if you are driving, you need to be careful. You should not drink alcohol when you are taking antihistamines like Claritin, Zyrtec, Benadryl, because they can accentuate your drowsiness.

People who are thinking about using decongestant nose sprays that are over-the-counter, they need to have extreme caution because decongestant nose sprays have a notorious side effect of causing rebound congestion if you use it continuously for more than three days in a row. You can use them once in a while, but if you use them more than three days in a row, they are going to cause rebound congestion and start an addiction type of a phenomenon, so people need to exercise high caution.

There is one thing people can try that is over-the-counter. Anybody can use it. It's something called neti pot. I am sure some of your listeners have heard about this, neti pot or sinus rinse. What it is, Heather, is basically water, salt, and baking soda, or some people just use water and salt, mix it together and kind of irrigate their nose and sinus with that solution. This particular type of treatment is actually more than two or three thousand years old, and it was initially used in India, and now it's marketed around the world as either neti pot or sinus rinse, or there are a variety of other forms that are used as well. That's fairly safe to use, and people can try it at home. It's a natural way to treat allergies.

Heather:

Well, are there some things outside of medication to help reduce allergy attacks?

Dr. Kelkar:

Yes, the one that I mentioned just now, neti pot or sinus rinse. That's kind of like a natural remedy, and that will definitely help people to reduce the allergy attacks. Many people will not like to use it because it's a little cumbersome. It takes a longer time. It's a little messier, and some people just feel too full in their nose and sinus as if they have gone swimming and their sinuses are filled with water. So some people may not like the feel of it, but it can work very well for some patients, so I think it is a good way to try at least something over the counter.

Heather:

What treatment options are there for people who can't get their allergy symptoms under control with standard medications?

Dr. Kelkar:

For patients who don't get it under control with standard medications, they definitely need to visit an allergist. If you visit a board-certified allergist, typically your visit will start with a detailed interview. They will take all of your history, a thorough physical examination and followed by specific allergy testing.

And after the allergy testing, depending on the allergy testing we will decide whether a particular person is a good candidate for allergy shots or not. And once people are a good candidate for allergy shots, or it is also called an allergy immunotherapy or allergy vaccine, then we can start the treatment. And what allergy immunotherapy or allergy shots are is basically a type of treatment where we try to build your body's resistance to fight allergies.

So let's assume, Heather, that somebody is allergic to dust mite, cat, dog, and pollen. What we typically do in such a circumstance is whatever the patient is allergic to, all of those things have allergens, we put in a small mixture, and we separate into different vials, and we start giving you those by injection at minute or miniscule doses first, and we kind of build you up to a maintenance dose where we increase the dose every time you get allergy injections, which are typically done once every seven days. And by increasing the dose of that allergen every week, we are trying to retrain your immune system so that it doesn't overproduce IgE antibodies, and it doesn't lead to allergy attacks.

Once we reach a top dose - what we call as a maintenance dose or top dose - for that particular individual, for that particular allergen, then we don't increase the dose of those allergens any further. And then you continue to get the same dose at certain intervals for a few years. And typically people will get the maintenance dose either every two weeks or every three weeks or once a month depending on how severe their symptoms are. So after the first six months, is actually not a big hassle because there are quite a few patients who will take them every two to three weeks or once a month, and then they will continue to manage their allergies very well just by retraining their immune system, if you will. It's a very, very natural way to treat allergies.

Heather:

We have some e mail questions, so let's get to it, Doctor. Cindy from Seattle, Washington says, “I get about eight sinus infections a year due to my allergies. My doctor has recommended sinus surgery, but I am concerned about going through surgery and not getting any relief. Do you recommend sinus surgery for allergy sufferers?”

Dr. Kelkar:

It depends on a particular situation. There are some patients who have recurrent sinus infections that can have underlying, severe allergies, and if we can control the allergies aggressively and adequately, we can control the sinus infections and prevent them to a certain extent. I would suggest that if you are in a situation like this, you definitely want to visit with a board-certified allergist and see if you are a candidate for allergy immunotherapy or allergy shots if you can do aggressive and adequate allergy management to prevent future sinus infections.

Keep in mind that there are some patients in whom the allergies or the sinus infections may be so severe that they may not only need the allergy management, but in addition to that, they may need surgery as well. So some patients will need both. They will need aggressive allergy management as well as surgery. But I do believe that medical management needs to be optimized and needs to be aggressively and adequately done before you consider surgery. So if you haven't given it a good shot, you definitely want to talk to a board-certified allergist.

Heather:

We have an e mail from New York. “Why are there so many more peanut allergies today? Is there anything to do to help one decrease allergic response to peanuts?”

Dr. Kelkar:

Right now there is more research being done as regards how we can prevent it. The American Academy of Pediatrics initially had put out a recommendation that if you have severe allergies in your family, and if your family is severely allergic to multiple things, then one of the things you may want to consider if you are pregnant is avoiding nuts and allergenic foods and see if that decreases the chance of your child developing allergies. But some of those things are called into question. We don't really have good evidence to support some of these concepts. So some of these concepts are still evolving, and some of the recommendations that you might see from different organizations may be based on some initial studies and based on expert opinion. But as far as the black and white answer, I think we still need to wait and see more research.

Heather:

We have an e mail from Minnesota. “Is there any relationship or link between food allergy and adult eczema or psoriasis?”

Dr. Kelkar:

Not with psoriasis, but food allergy is definitely related to atopic dermatitis. Atopic dermatitis is a skin condition that starts very, very early in life. In fact in some children, it can start right after birth in very early time of your life, and it leads to skin rash on your cheeks, under your arms, and in the forearm and behind the knees and in the elbows. And it can be pretty severe, and that has been associated with food allergy. In fact, about 30 to 40 percent of atopic dermatitis children can have associated food allergies. Not with psoriasis, though. That's a completely different ball game.

Heather:

I had a little boy that had a lot of eczema, but he didn't have any food allergies. He just had a lot of asthma and medication allergies.

We have an e mail from Rochester, New York. “What symptoms signal adult onset food allergies?”

Dr. Kelkar:

Food allergies typically will manifest as throat closing, shortness of breath, asthma type of symptoms, lip swelling, tongue swelling, face swelling, itching all over the body, nausea, vomiting, abdominal pain, diarrhea. These are the common symptoms from food allergy, and they typically start within few hours of ingesting the food. If you have eaten some food 24 hours ago and if you are having the reaction right now, it's probably not related to the food that you ate 24 hours ago. So it should start within a reasonable time frame, within a few hours after eating that food.

Heather:

How can you separate foods to know which one you ate that's causing that reaction?

Dr. Kelkar:

That's why we have to ask people to keep track of what foods they have eaten before they had the reaction. Sometimes we have to ask them to keep a food journal so that they bring the journal with them and tell us what reaction they had, what they ate before that, and what was the label of the thing that they ate. Because a lot of people eat stuff from a grocery store, and they say, “Oh, I ate this thing,” and they may not even remember the details of what is in it. So we have to have them bring the labels of the food that they ate.

Heather:

Yes. Because I don't remember seeing a label recently that only had one ingredient listed.

Dr. Kelkar:

That's absolutely correct. Sometimes you are surprised. You go to the grocery store to buy potato chips, and you find 30 things in there. You are wondering what's going on.

Heather:

We have an e mail from Hannover, Massachusetts. “How can you be certain one has outgrown a peanut allergy, and it's safe to eat peanuts again?”

Dr. Kelkar:

That really needs a very, very thorough work up by a board-certified allergist because in such a situation what we are going to do is initially we are going to do skin testing, blood testing. Some patients will need both. They will need skin testing and blood testing. Then what we do is if you have the blood test from before, we will compare the number in the blood from before versus the number today, and then we will see if there is any decline in that number. If the decline in the number is significant enough, or if the skin test as well as blood test is completely negative, then the next step is going to be oral food challenge under physician supervision.

What that means is that we bring the child either to our clinic or to a hospital, and we feed the child peanut allergen in a gradually increasing form. I want to remind your listeners that this thing should not be done at home unless your board-certified allergist tells you to do so. This should be done at the clinic or at the hospital, and your board-certified allergist will make that decision whether the oral challenge can be done at home versus in the clinic or in the hospital, because even if the skin test is negative and even if the blood test is negative, there are patients who can have allergic reactions, and sometimes those reactions can be life threatening. So the gold standard is oral challenge under physician supervision.

Heather:

I'm kind of curious. Why would they think they would have outgrown that allergy?

Dr. Kelkar:

Fifteen percent of them do outgrow allergies, and we all have grandmas and grandpas or relatives and friends around who sometimes forget that the child has allergies and mistakenly the child is given a cookie that is baked with peanuts in it, and somebody forgot to tell the parents that this has peanut in it, and by mistake the child consumes that cookie, it has peanuts in it, and the child is allergic to peanuts, but the parents find that now there is no reaction after eating that cookie. And now they say, “Well, maybe he has outgrown the allergy.” In that circumstance, then you will need to reconfirm sometimes.

Heather:

An e mail from New Jersey asks, “I seem to have allergies, but tests have come up empty. I usually buy the equivalent of Claritin at Target. It works for me. Is taking that medicine every day bad for me? I take it twice a day.”

Dr. Kelkar:

Two things - number one, we have allergy skin testing and blood testing. I don't know what the person did, the person who e mailed you, whether she did blood testing or whether she did skin testing. Sometimes the blood testing can be false negative, and we have to do skin testing to make sure that it is really negative. If somebody's blood testing and skin testing both are negative, but they are having allergy symptoms, and they are feeling better by using Claritin, it is okay to use that, and I don't anticipate any big risk of side effects if they have to use it long-term.

One caution, though. Many times people call Claritin, but they are actually using Claritin D which has a very, very high dose of Sudafed or decongestant, and I particularly won't feel comfortable in taking high dose Sudafed on a daily basis all my life. If they are just taking Claritin, and if they are not having side effects, and if it is helping them, I think it's a reasonable idea.

Heather:

But not the Claritin D.

Dr. Kelkar:

I personally would not feel comfortable taking Claritin D all my life on a daily basis.

Heather:

Let's go to an e mail from Idaho. “My one year old daughter cannot drink cow's milk without getting very sick, sometimes throwing up and breaking out. Is she allergic, or could it just be a lactose intolerance? And what's the difference?”

Dr. Kelkar:

Lactose intolerance is very different than food allergy. Foods allergy reactions are mediated by IgE type of antibodies, and food allergy type of reactions can be life threatening. In other words, if nausea, vomiting, diarrhea is coming from food allergy, and if you continue to feed that child the same allergen, at some point there is a potential risk that there can be a life threatening reaction.

Lactose intolerance can never be life threatening. I mean, you can have a profuse diarrhea and you may get dehydrated sometimes, but it's not life threatening in the sense that it's not going to cause you shortness of breath or throat closing, that you cannot breathe. So lactose intolerance is a completely different form than food allergy.

It is very, very important that in cases like you just described they need to visit with a board-certified allergist to separate the two phenomenon. Because in lactose intolerance it is not life threatening. Food allergy can be life threatening. In food allergy, you have to avoid the allergen strictly 100 percent continuously unless and until the person has outgrown allergy. People who have food allergy need to carry epinephrine injection, adrenaline injection like EpiPen or Twinject with them all the time because they have a potential to develop life threatening reactions from them.

Heather:

And she can't tell just from the symptoms whether it's intolerance or an allergy?

Dr. Kelkar:

From the symptoms it's very hard to tell because vomiting can be from food allergies. Vomiting generally doesn't happen with lactose intolerance. Lactose intolerance is typically abdominal bloating, diarrhea, nausea, those kinds of symptoms. At that particular age, I would suspect food allergy is more likely than lactose intolerance, although this particular person needs a thorough evaluation before you can come to a specific diagnosis.

Heather:

Let's go to an e mail from Orlando, Florida. “As a child and teenager, I was unable to eat chocolate candy bars because I would break out all over my face. As an adult, I can eat candy bars all day and every day without breaking out. I have been told that I was allergic to the chocolate candy bars, and that I was just experiencing puberty. Is that true, or did I outgrow my allergic reaction to it?”

Dr. Kelkar:

Chocolate allergy has been reported in the literature, but it's very, very rare. I probably have seen just one or two patients when I was working at the Mayo Clinic, and it's extremely rare, but it's been reported in the literature. It's possible that in some patients who feel that they are allergic to chocolate, they actually may be allergic to some other ingredient in the chocolate. Maybe it was allergy to milk. Maybe it was allergy to some nut, peanut or tree nut that was present in the chocolate. Maybe it was allergy to some flavoring in the chocolate or maybe something else and not necessarily chocolate per se.

Heather:

We have an e mail from Cheney, Washington. “Why are sudden changes in weather such a powerful trigger for allergies and subsequently asthma attacks in people such as myself?”

Dr. Kelkar:

Changes in weather typically bring different levels of pollen. For example, if you have a day in springtime that is just calm without any wind and just milder weather versus the second day that is windy and warmer, the day that is warmer and windy and dry is going to have very high pollen count circulating in the air. And if you are allergic to pollen, then the pollen is not only going to trigger your allergy symptoms but is also going to trigger your asthma. That's why many times weather changes are related to our allergies and asthma attacks.

Also, there are some types of mold that are specifically associated with lightning. So if you see a lot of lightning, after the lightning there are some cases where the mold exposure can be higher in the environment. And if you are allergic to a particular type of mold, then sometimes you are going to get exposure to that, and you can have reaction. When people go out and if it's raining, they may not notice the allergic reactions because the rain settles down all the pollen. But guess what? When the rain stops and next day you have warmer weather and dryer weather, immediately the pollen counts skyrocket, and you are going to have significant allergy symptoms, and the allergy symptoms will develop into asthma as well.

Heather:

That makes sense. We have an e mail, a question from Jared in Los Angeles. “I used to be very allergic to eggs, and it only took a little bit for a reaction. Now it takes a lot more, but I still get a reaction. Is that possible? Or could it be something else?”

Dr. Kelkar:

No, it's definitely possible. Allergy to egg as well as all other types of food is dependent on the dose. In other words, there are patients who will have food allergy only when they ingest a certain amount of the allergen. For example, I have had patients who had one tiny, tiny bit of egg and had no reaction, so they could tolerate egg in a cake, for example. But if they had scrambled eggs, they had a severe reaction. The problem is you can never predict whether that is going to change over time. So today you may not be reacting to egg unless it is half a teaspoonful, but tomorrow whether you are going do react to a tiny, tiny bit of egg or whether you are going to need three teaspoons full of egg before you show the reaction, we can't predict that. That's why if the patient is allergic to egg, we tell them to strictly avoid egg 100 percent in all forms until they have outgrown allergy.

Heather:

We have an e mail from Sacramento, California. “When I was in college, I had a really bad allergic reaction to proteins in seafood. Fifteen years later I seem to have outgrown it. But I have a six year old daughter that is allergic to seafood. Is it possible that she will grow out of it by the time she's an adult? I have heard that kids don't always outgrow seafood allergies, and if it's true, why is that?”

Dr. Kelkar:

Yeah. Usually people do not outgrow peanut allergy as well as seafood allergy. But as I always say, there are exceptions to the rule. So as an exception you probably can outgrow them, but a majority of the patients will not outgrow seafood allergy and peanut allergy.

Heather:

Can you make a prediction about her daughter since the mother outgrew it?

Dr. Kelkar:

You really can't predict just based on that.

Heather:

An e mail from Oklahoma asks, “I can eat homegrown tomatoes, but if I buy one from the grocery store that has been picked green and ripened artificially, I have a severe allergic reaction. The same if I use tomatoes in a can. I can eat home canned with no problem though. Why is that?”

Dr. Kelkar:

It's possible that the person that you just described may have some reaction to preservatives or artificial stuff that is used during processing. That is a possibility. That's the only thing I can think of, because otherwise the content is about the same.

Heather:

So this is back to what we were talking about, the label, the contents, and all those mystery things that we don't know are necessarily there.

Dr. Kelkar:

Yes. Just from a health perspective, going beyond allergy, I would strongly recommend all of the listeners just out of awareness and curiosity try and read labels on everything you eat. You are going to be surprised to find potato chips containing 30 things because common sense will tell you that you will just have potatoes, salt, and oil. But you are going to find 30 things, and you are going to be taken aback.

Heather:

Yeah. We have a question from Jennifer from North Carolina. “I have an EpiPen for my food allergies, but I am terrified to use it. I have never had to use it, but what side effects can I expect to see if I do have to use it?”

Dr. Kelkar:

She is not alone. There are quite a few people who may not feel comfortable in using an EpiPen. A couple of things they can do. First of all, they should have good training in using an EpiPen from their healthcare provider. Second of all, they can go to the Web site of EpiPen or Twinject or whatever device they have, and most of the Web sites will have detailed information. Some of them will have even videos about how to appropriately use it. They will also have detailed information of what side effects can occur. The third thing they can do is if they have an expired EpiPen at home, before they actually throw it away, what they could do is buy an orange and practice on orange with an expired EpiPen or Twinject so that they know how to use it so that they can feel comfortable.

Heather:

So they get a feel for it?

Dr. Kelkar:

Yes, so that they get a feel for it. They get the hang of it. And there are always demo units in allergists' offices, and I am sure they can find them in primary care offices as well. But you can practice with a demo unit without a needle in it on yourself. That will give them some experience, some practice, some confidence.

Side effects can occur like jitteriness, rapid heart rate, the person might feel as if they just had five to ten cups of coffee. Those are the common side effects. And some people may feel a little flushed in the face or upper part of the body. Keep in mind that EpiPen, Twinject, or adrenaline injections or epinephrine injection is for emergency. So it's for a life threatening reaction, so it's kind of risk versus benefit.

Heather:

So, better to feel jittery than to not feel anything?

Dr. Kelkar:

That's correct.

Heather:

We have an e-mail from Pittsburgh, “Are persons with asthma more likely to develop allergies after they outgrow the asthma, i.e., ending up with food allergies that they didn't originally have?”

Dr. Kelkar:

Once you have asthma, if your asthma has allergic tendencies, in other words if your asthma was allergic asthma, and if you have outgrown asthma, that would tell me that because your asthma was allergic asthma, you have a genetic predisposition for allergies. And once you have genetic predisposition for allergies, it is possible that you have more chance of developing allergies than somebody else in the population who doesn't have that genetic predisposition.

Heather:

We are just about out of time, but before we go, I would like to get some very quick final thoughts from you. Dr. Kelkar, what would you like to leave our listeners with very quickly?

Dr. Kelkar:

The one thing I would like your listeners to be aware of is that there are so many treatment options available for allergies and asthma these days that you can lead a perfectly normal life. You can enjoy outdoors as much as you want. You just need to get the right treatment. You need to visit the right specialist, and you should continue to enjoy the outdoors and whatever you like to do in terms of physical activity and exercise.

Heather:

Good. Thank you. I wanted to thank Dr. Kelkar and you, the listeners, for joining us.